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R�cipient Commitbee <br /> Campaign Statement <br /> Cover Page <br /> (Government Code Sections 84200-84216.5) <br /> SEE INSTRUCTIONS ON REVERSE <br /> Type or print in ink. <br /> Statement covers period <br /> from I 7 ! ��(D <br /> through n � <br /> 1. Tj/p@ Of ReClPlellt COm�Tti�ee: All Committees-Complete Parts 1,z,s,and 4. <br /> ❑ Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure <br /> Q State Candidate Election Committee <br /> Q Recall <br /> (Also Complele Part 5) <br /> [�General Purpose Committee <br /> Q Sponsored <br /> Q Small Contributor Committee <br /> Q Political Party/Central Committee <br /> Committee <br /> Q Controlled <br /> Q Sponsored <br /> (Also Compfefe Part 6) <br /> � Primarily Fortned Candidate/ <br /> Officeholder Committee <br /> (Also Comptete Part 7) <br /> 3. Committee Information I I.D. NUMBER <br /> COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) ' <br /> �jQ I E�"i�'S C�� ���v� �f T�' �f�� <br /> STREET ADORESS (NO P.O. BOX) <br /> �fi5 d [J-��t� <br /> Date of election if appl <br /> (Month, Day,Year) <br /> Date Stamp <br /> � � � uu � � <br /> S E P 1 2 2006 ' . <br /> Type of Statement: <br /> ❑ �lection Statement <br /> Q�Semi-annual Statement <br /> ❑ Termination Statement <br /> (Also file a Form 410 Termination) <br /> ❑ Amendment(Explain below) <br /> Treasurer(s) <br /> NAME OF TREASURER <br /> /' _ . i 1� / <br /> CIN <br /> COVER PAGE <br /> Page_.L— of_l. <br /> For Official Use Onty <br /> ❑ Quarterly Statement <br /> ❑ Special Odd-Year Report <br /> ❑ Supplemental Preefection <br /> Statement-Attach Form 495 <br /> ��� � ����� <br /> CITY � , , _, , STATE ZIP CODE f1REA CODEIPHONE <br /> ; <br /> 4. Verification <br /> i have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the informa' n contained herein and in the attached schedules is true and complete. I certify <br /> under penalty of pery'ury under the laws of the State of Califomia that tfie foregoing is true and correct. <br /> Executedon / ( `��fn(n gy ` <br /> Date Sig ure of Treasur or Assistant Treasurer <br /> Executed on By <br /> pate Signature W Controliirg Office}wlder,Candidate,State Measure Proponent or Responsible Officer of Sponsor <br /> Executed on <br /> Date <br /> Executed on <br /> Date <br /> ey <br /> Si�ature of Controlling Officeholder,Canddate,State Meesure Proponent <br /> By <br /> SignaNreotConlroNingOfficehoider,Candidate,5tateMeasureProponent FPPC Form 460(JBnudry/05) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) <br /> State of Californla <br />